# The impact of sociodemographic background on clinical presentation of high-grade gliomas: a multi-institutional retrospective analysis

## TL;DR

This study finds that race and ethnicity influence the age and symptoms at diagnosis for high-grade brain tumors, with White patients diagnosed later and showing different symptoms compared to Black and Hispanic patients.

## Contribution

The study is the first to show race- and ethnicity-related differences in clinical presentation of high-grade gliomas.

## Key findings

- White patients were diagnosed at a later age and more often presented with cognitive deficits.
- Black patients were more likely to present with syncope, and Hispanic patients with seizures.
- White patients had less imaging signs of mass effect and midline shift compared to non-White patients.

## Abstract

High-grade gliomas (HGG; WHO III/IV) are among the most devastating intracranial malignancies, and outcomes may be associated with demographic, biological and environmental factors. Although research exists on the association of sociodemographic background with outcomes, the literature lacks data on the effect of sociodemographic background on clinical presentation. In this study, we aimed to examine race- and ethnicity-related differences in HGG presentation and diagnosis.

We conducted a chart review of patients treated for HGG between 2015 and 2021 at three high-volume academic medical centers. A total of 314 patients were analyzed. 173 White patients were included along with 144 non-White patients, comprising of Asian (16%), Black (26%), Hispanic (9%), and other/declined (50%) race. Statistical analysis was carried out using GraphPad Prism.

On multivariate analysis, White race was significantly associated with a later age at diagnosis independent of IDH1 status. White patients were more likely to present with a cognitive deficit (42.3% vs. 21.1%; p = 0.02*), while less likely to present with midline shift (32.5% vs. 49.3%; p = 0.004**) and mass effect on imaging (59.8% vs. 76.1%; p = 0.003***). Additionally, Black patients were more likely to present with syncope (15.8% vs. 2.3% [n = 107]; p = 0.04*) and Hispanic patients were more likely to present with seizure (35.7% vs. 15.9% [n = 110]; p = 0.03*).

White race appears to be independently associated with a later age at diagnosis of HGG. Furthermore, Black and Hispanic patients are more likely to present with severe, life-threatening symptoms. Large-scale studies are needed to elucidate race-based differences in HGG presentation to effectively predict outcomes.